Decreased Cost without Increased Risk of 90-Day Complication or Readmission with Total Joint Replacement in a Private, Community-Based Ambulatory Surgery Center

Introduction: The increased popularity of ambulatory total hip (THR) and total knee replacements (TKR) has come alongside concern for increased risk due to the surgery being performed in an ambulatory surgery center (ASC) as opposed to a traditional hospital setting. We aimed to compare the 90-day complications readmission rates, and cost for THR and TKR patients that were performed either in a community ASC or an academic facility.

Methods: 126 unilateral THR or TKR patients with same day discharge from a community-based ASC were 1:1 matched based on surgical procedure, age, sex, BMI, ASA Classification and Charlson comorbidity index with 126 patients who underwent THR or TKR in a hospital setting with an overnight stay. Patients were evaluated for 90-day complications, readmission rates, and total cost. Statistical analysis was performed for descriptive statistics and a two-sample t test was used to compare rates.

Results: 77 TKR and 49 THR patients per group. There was no significant difference in demographics between the two groups. Average length of stay for the hospital group was 23 hrs 34 min (6hr 3min-27hr 41 min; THA 11 hr 45mins-27hr 2min) and for the ASC group was 8 hrs 9 min (TKA: 6 hrs 5 mins ­­-10 hrs 10 mins; THA was 6 hrs 15 mins - 10 hrs 40 mins​). The complication rate for in-patient was 3.9% versus 2.4% at the ASC. Further, there were no significant difference in regards to complication rate (p=0.47) or readmission rate (p=0.15). Average related, in-patient costs are $19,361 compared to ASC $11,677, resulting in a 60% cost reduction for same day discharge.

Conclusion: Despite possible concerns, there is no increased risk of complications or readmissions when THR and TKR are performed in a community-based ASC. An ASC provides a viable option for these surgeries with a considerable cost benefit.